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The latest in the litany of "this is linked to autism" findings is abuse of the mother in childhood. Researchers publishing in JAMA Psychiatry report that women who experienced the "highest level" of abuse when they were girls had about three times the risk of non-abused women of having an autistic child. In the current work, based on data collected in the course of the large Nurses' Health Study II, the authors looked at data for 54,963 women who reported in 2005 whether or not they had a child with autism. The women also completed a 2001 questionnaire about their experiences with childhood abuse. Of this group, 451 were the biological parent of an autistic child.

The authors offer four possible explanations for the mathematical link they identified between maternal childhood abuse and having an autistic child. The first is that they left out some other important factors, such as infection or poor diet. The second, to which they devote the most words, is that imbalances of various interacting stress-related pathways, including inflammation, somehow led to autism in an abused woman's child. Their third possibility still ties in inflammation, but this time, epigenetic factors--influences on the mother's gene expression--would be to blame. Finally, they posit that childhood abuse often comes from mentally ill family members and suggest that a genetic link between mental illness and autism might explain the findings.

The one genetic possibility they left out is that the women themselves might have been autistic but undiagnosed or have shown traits of autism without meeting the threshold definition of it. Unless their manifestation of autism is quite intense, girls and women often go undiagnosed or are diagnosed with personality or other disorders. In addition, because of some of the key behaviors associated with autism, autistic children are more likely--much more likely [PDF]--than non-autistic children to be abused, physically, emotionally, and sexually. A girl showing even some of those traits, or a "broad autism phenotype," is not excluded from being a target just because she never had an autism diagnosis. Appearing unresponsive to discipline, "overly" sensitive to inputs from the world around them, unable to read nonverbal communication, including building anger or threat or bullying -- all of these can and do translate into abuse from family members, caregivers, peers, and others and leave a girl like this vulnerable.

A review of one of the questionnaires the study uses (the 2005 version [PDF]) turned up no questions pertaining to autism traits in the mother or questions asking about having an autistic child. Indeed, a very small number of questions relate to behavioral or mental health, primarily phobias and anxiety, and almost none to neurological health; a version from another year seemed to focus on depression. I wonder what the researchers would uncover if they asked these mothers, for example, about their social experiences in childhood, their sensory experiences, their response to stimuli, and other questions relevant to autism. These kinds of queries would be one way to tease out whether or not autism or autism-related traits in the mother were another contributing factor not only to autism in the child but also to maternal childhood abuse.

What would the relevance of autism traits in the mother be? Genetics investigations suggest a strong genetic component to autism, and one recent study found that autism might trace to an accumulation of many, many gene variants acquired from both mom and dad. Furthermore, families with more than one autistic individual, in particular, not infrequently turn out to be replete with members who show the "broad autism phenotype." Given the preponderance of genetic involvement in autism, genetics and autism traits in the mother certainly stand as an obvious possibility for what underlies correlation between maternal childhood abuse and autism, far more so than the lingering effects of stress-induced inflammation (stress response is idiosyncratic and could arise from many factors other than abuse) or epigenetics. Not coincidentally, both of the latter are among the sexiest explanations for all things health right now.

Epigenetics carries its own set of problems, articulated quite well in this series of posts. And inflammation and the immune system are becoming the "low vitamin D" of this decade. No matter what the disorder, inflammation and the immune response are the explanatory code words du jour. In one sense, that ubiquity is kind of a "duh": The immune system isn't the Lone Ranger of physiology. It engages with and responds to all other body systems, and those other systems all return the favor; no physiological system is an island. So, sure, the immune system and inflammation are probably involved in practically everything. But that doesn't make them the direct explanation for everything any more than sneezing is what gives you allergies. It's one result of the allergy, not the cause.

I wonder how the autistic women I know would rate the following experiences in their childhoods. These are the types of non-sexual abuse the authors queried participants about, asking them to assign values from 0 (never) to 4 (very often true): Did the respondent experience any of the following from family members: hitting so hard it left bruises; punishing in a way that seemed cruel; insulting, screaming, and yelling; and punishing with a belt or other hard object? Anecdotally, I know that for many autistic women, the values they'd assign to these would be on the high end. And I know that anyone who grew up where I did in the 1970s, male or female, was a target for this treatment everywhere--at school (even from principals and teachers) and at home. Back then, they called it "discipline" or brushed off bullying as "normal." Today, it's (rightfully) called abuse.